Vaginismus

(Psychogenic Vaginismus)

Definition

Vaginismus is an uncontrolled, involuntary spasm of the vagina muscles. These spasms cause sexual intercourse to be painful. It is a complex disorder because it is both a psychological and physical condition.

Vaginismus is uncommon, less than 2% of women in the United States are affected. It can cause severe physical and psychological pain. If you suspect you have this condition, talk to your doctor.

Causes

Vaginismus is usually a response to past sexual trauma or other painful circumstances. The fear of pain can trigger a painful muscle spasm, in which case sex is then associated with fear and pain. Sometimes no cause can be found.

There are two forms of vaginismus, primary and secondary. Primary vaginismus is diagnosed in women who have never had successful sexual intercourse due to pain or its anticipation. Secondary vaginismus is diagnosed if a woman has had a successful experience with intercourse in the past.

Risk Factors

A risk factor is anything that can increase the chances of a condition. Known risk factors for vaginismus include:

History of sexual abuse or trauma

A frightening childhood medical procedure

Painful first intercourse

Relationship problems

Sexual inhibition

Fear of pregnancy

Memory of previous pain due to infection, surgery, or other gynecologic conditions

Symptoms

Symptoms of vaginismus can range in severity. Women with this disorder are not able to have sexual intercourse without pain. Some women may also experience pain during pelvic exams or while inserting a tampon.

Diagnosis

Your doctor will ask you about your symptoms and medical history, as well as perform a physical exam. Your doctor may be able to observe a vaginal spasm during the pelvic exam, and confirm the diagnosis of vaginismus.

The insertion of a speculum may be impossible and vaginal secretion may be minimal. In severe cases, local or general anesthesia may be used to perform an exam.

Treatment

Kegel Exercises

Kegel exercises cause the repetitive contraction and relaxation of the pelvic muscles. The exercises can help improve control over the vaginal muscles.

Vaginal Dilation Exercises

Vaginal dilation exercises use the patient's own fingers or plastic instruments called dilators. The dilators are gradually increased in size and placed in the vagina over time. Women may be asked to practice Kegel exercises while the dilators are in the vagina.

Once patients have reached a certain tolerance, sexual intercourse is attempted. Patients may be asked to place the dilators themselves, but the program is supervised by a healthcare provider.

Educational Treatment

Fear of sex is a large part of this disorder, so educating women is an important part of treatment. Women are taught about sex organs and how they work. The sexual response cycle and common sex myths are also discussed.

Counseling

Depending on the cause, psychological counseling is often central to the treatment of vaginismus, particularly primary vaginismus due to sexual abuse or trauma.

Prevention

To help reduce your chances of getting vaginismus, talk to your doctor or healthcare provider right away if you experience pain with intercourse. Vaginismus can become an automatic response if the pain is not treated promptly.